A urinary diversion is a surgical procedure to reconstruct or re-route the urinary tract to allow urine to exit the body in a safe manner. The urinary tract consists of kidneys which filter blood and produce urine. This allows extra fluid and waste products to leave the body. The produced urine exits each kidney via a tube called a ureter, which travels the length of the abdomen and enters into the back of the bladder. The bladder stores the urine until an individual has to void, at which time an individual urinates through a urethra.
There are many reasons why an individual may need to have this procedure performed, ranging from benign conditions such as scar tissue to more concerning situations like bladder cancer. A urinary diversion most commonly is referred to as a “urostomy,” which requires an external appliance or pouch to be attached to the abdominal wall to collect the urine. This type of diversion is also referred to as an incontinent diversion, which means the individual does not control when the urine leaves the body and the pouch has to worn at all times to be dry.
Indications someone needs a urostomy could include bladder cancer, radiation to the prostate or bladder, nerve damage to the bladder, neurologic disorders (such as multiple sclerosis, stroke or cerebral palsy), spinal cord injuries, pelvic trauma, urinary fistula (abnormal communication with the urinary tract), pelvic cancers, chronic infection or inflammation of the bladder, or severe urinary incontinence.
Procedure
A urostomy is the creation of a new passage route for urine to exit the body. A short section of small bowel, generally 12-14 centimeters, is used to form the conduit. The remaining bowel is reconnected to allow for normal bowel function after surgery. The ureters are disconnected from the bladder and sewn into one end of the conduit. The bladder may then be removed. The opposite end of the conduit is brought to the surface of the abdominal wall. The site is usually in the lower right side of the belly. The stoma or opening of the conduit is then created at the skin as is generally the size of a quarter once healed.
This surgery is permanent and patients in the future will need to wear a collection pouch/ostomy appliance over the stoma to control the urine. The short section of the conduit made out of bowel will continue to produce mucus naturally. Individuals with a urostomy will notice mucus collecting in their pouch/appliance at times. This is normal and expected.
Potential complications of this surgery include urinary tract blockage or obstruction, bleeding, infections, stoma-related problems, kidney stones, bowel leak or obstruction, kidney deterioration or blood clots.
Urostomy Care
After the diversion surgery, wound-ostomy nurses meet with patients in the hospital to help orient and familiarize the patient with the care of urinary diversion. Most pouch systems consist of two pieces: a wax wafer which sticks to the skin and provides a water-tight seal to prevent leakage and accidents and a pouch which attaches to the barrier.
The urostomy appliances will need to be changed occasionally. It is important to completely clean the skin around the stoma prior to placing a new pouch to achieve a tight seal. Sometimes the skin in this area may become red or irritated. If this occurs, the wound-ostomy nurses may recommend special skin wipes or ostomy power/paste to help heal and protect the skin.